Provider Demographics
NPI:1588769731
Name:COOKEVILLE URGENT CARE
Entity type:Organization
Organization Name:COOKEVILLE URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-520-0148
Mailing Address - Street 1:106 N WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2554
Mailing Address - Country:US
Mailing Address - Phone:931-520-0148
Mailing Address - Fax:
Practice Address - Street 1:106 N WALNUT AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2554
Practice Address - Country:US
Practice Address - Phone:931-520-0148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3343242Medicare ID - Type Unspecified